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Despite changes to mandatory reporting obligations in 2018, many Australian doctors remain hesitant to seek treatment for mental health concerns, fearing they might be reported to the regulator. Dispelling this perception is vital to ensure doctors seek treatment when they need it.
One of the most common concerns we hear at Avant is that a treating doctor may be obligated to notify the regulator when their doctor-patient seeks mental health treatment. This fear is largely unfounded.
Across Australia, the threshold for a treating doctor to make a mandatory report about a doctor-patient is intentionally high.
In Western Australia, treating practitioners are completely exempt from making a mandatory notification (s141 of the Health Practitioner Regulation National Law [Western Australia] 2024).
In all other states and territories, a treating doctor is only required to notify a regulator if, during the course of treatment, they become aware that the doctor-patient:
- is practising their profession in a way that poses a substantial risk of harm to the public; or
- has engaged in, is engaging in or is at risk of engaging in sexual misconduct related to their professional practice.
As outlined in section 3 of the Guidelines: Mandatory notifications about registered health practitioners, both the Medical Board of Australia and the Australian Health Practitioner Regulation Agency (Ahpra) acknowledge that this is a high threshold for reporting by treating doctors. The intent behind this is clear: to ensure doctors can access treatment for mental health issues without fear of being reported.
Health condition is not the same as impairment
Another common concern for doctors arises during their renewal process when they fear acknowledging a mental health issue will be reported to the regulator. Again, this is a misunderstanding.
Each year, Avant hears from doctors who become concerned about their health when completing their registration renewal form because of the questions it asks about “impairment”.
The Health Practitioner Regulation National Law (Queensland) Act 2024 (s5) defines “impairment” as “a physical or mental impairment, disability, condition or disorder (including substance abuse or dependence) that detrimentally affects or is likely to detrimentally affect … the person’s capacity to practise the profession”.
Taken literally, any condition — even a headache — might detrimentally affect a person’s capacity to practise the profession. Understandably, such vague wording, repeated annually in renewal notices, can discourage doctors from disclosing mental health concerns.
Thankfully, the Medical Board of Australia has confirmed in section 2.3 of the Guidelines that a health condition — including a mental health condition — is not the same as an impairment. It is accepted that illness, including mental illness, which is treated and well managed, would rarely be considered an impairment requiring notification to the regulator.
Prioritise mental health and seek help
Doctors, like anyone else, are not immune to mental illness and the pressures we all experience in life. But they also face unique, high-pressure environments that can contribute to stress, burnout and psychological distress.
These pressures are compounded by fears about the regulatory notification process. In a 2023 report, Ahpra revealed that 16 health practitioners died by suicide and four others attempted suicide or self-harmed while involved in a notification complaints process within a four-year period.
These sobering statistics underline the urgent need for doctors to prioritise their health and seek help if they are suffering from stress, burnout, anxiety or depression. This principle has been incorporated into the Medical Board of Australia’s Good Medical Practice: Code of Conduct (clause 11.2.3).
Despite this guidance, doctors remain reluctant to seek treatment for mental health concerns, according to feedback provided to Avant and doctors health services.
Fortunately, organisations like the Black Dog Institute are responding to this reluctance, aiming to counter fears about mandatory reporting among health practitioners and establishing The Essential Network to provide critical mental health advice and wellbeing support to health care workers.
The National Doctors Health & Wellbeing Leadership Alliance is also taking coordinated action through the Every Doctor, Every Setting Framework to prevent mental ill-health and suicidal behaviour, and to support good mental health for all doctors and medical students.
Just as we are now dispensing with outdated judgements about mental health, it is time for doctors with mental health concerns to seek the care they need when it’s needed.
It is in all our interests to encourage them to do so without hesitation, stigma or fear.
Tracy Pickett is a legal and policy adviser at Avant Mutual. She is also a director of the AEIOU Foundation.
Professor Steve Robson is chief medical officer at Avant Mutual. He is also chair of the National Doctors Health & Wellbeing Leadership Alliance, professor of obstetrics and gynaecology at the Australian National University, and a council member of the National Health and Medical Research Council.
Conflict of interest statement: The authors are employed by Avant Mutual. Professor Robson is chair of the National Doctors Health and Wellbeing Leadership Alliance.
The statements or opinions expressed in this article reflect the views of the authors and do not necessarily represent the official policy of the AMA, the MJA or InSight+ unless so stated.
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I am afraid this is not the case. I myself suffered from a mental health condition. After delay seeking helps for years , afraid that I would not be able to work. Since I have finally seeing psychiatrist to get help, conditions have been on my registration since, even my psychiatrist says there is no need for such conditions. What is worse is that my solicitor advised me that even medical tribunal does not have the authority to remove these conditions. They are up to the regulators, is AHPRA. The only way to fight them is to go to the high court.
I’m sorry. Yet another instance of Avant being an apologist and supporter of the medical regulator, which doesn’t give a toss about medical practitioners mental health. The regulator is a major contributor to poor mental health amongst doctors. Avant is a major player in the field and has done little or nothing to push back against the regulator. Writing articles like this only supports this view. Doctors remain reluctant to seek treatment for mental health concerns with good reason. Your article does nothing to quell this.
We only need to look as far as the efforts made by AHPRA to persecute doctors protecting themselves from harm to know that it is not safe to be a doctor let alone a doctor trying to protect themselves from harm.
See Mahboub v Medical Board of Australia [2024] SACAT 92
And be afraid, be very afraid.
The number of doctors harmed by AHPRA’s handing of notifications to the point of suicide is far greater than the 16 directly attributable deaths. Far more than 4 have attempted suicide and far, far more have considered suicide as a reasonable option.
Those figures were collected by AHPRA on AHPRA’s behalf and can only be seen to be the tip of the iceberg.
Perhaps Avant might want to include the cases in which they have been directly involved. Avant’s capitulation to AHPRA was the cause of my suicide attempt.
A surgeon in Melbourne was mercilessly persecuted for a mental illness that never existed. His complaints to AHPRA in 2018 have resulted in seven years of persecution by AHPRA. The expert evidence from 2019 showed there was no mental illness or impairment. And yet the Board only ended the immediate action in 2024 but continued to persist with allegations of mental illness at VCAT until the week before the hearing!
Now the Board are attempting to cancel the surgeon’s registration for expressing his experiences of the false allegations on social media! The hearing has been interrupted by the recusal of the Senior Member for insinuating that the surgeon is a Nazi sympathiser!
Could there be anything less encouraging for anyone to speak up about their health?
When I had to face up to a MBA review commitee due to a reporting by a doctor who by the nsture of his role of my medical college came across my diagnosis, i was still having to deal with the implication of my diagnosis, There was no evidence of the diagnosis affecting the care of my patients nor the professional conduct.
The year was 2013, there was no formal mandatory report for mental health then. There is no doubt that despite claims of the notifier that “he was not familiar with the nature of the diagnosis”, that he reported me “out of caution”, there was a definite intention of malice as far as I was concerned, as it had occured only after the college (and himself) found itself on the losing side of a dispute.
The committee cleared me after one meeting, but the stress involved having to front up to a MBA meeting with preparation, legal representation and supporting statemnets, was unnecessary, avoidable and certainly an act of a last sting from the college officeholder.
Do I think the mandatory reporting is necessary? No. It will not pick out the problem doctors it proport to do.
Do I think mandatory reporting for mental health save patients from poor healthcare interaction? No. All the sensational news involving outrageous care did not involve doctors who have pre-exisitng mental health diagnosis (nor did they sought to use it as a safe refuge for their action)
Do I think mandatory reporting will drive doctors not to seek care? Absolutely. As all mental health diagnoses formally made by pyschiatrists and psychologists, all of whom are regulated by APHRA, there is no doubt a valid concern (regardless of any reassurance) that the uncertainty of the regulator action in response to this reporting will result in unncessary stress, legal involvement, financial hit as well as personal crisis, in addition to the impact of the diagnosis and management of the mental health issues.
Show me how this mandatory reporting help the doctors and patients (they have 7 years of experience now) and maybe I will reconsider
A rigid centralized rules based machine bureaucracy like AHPRA and its boards is the wrong structrure for disclosing complex and sensitive matter like impairments to, especially given the mistrust AHPRA has earned itself. Small, agile, well-informed senior clinician led professional bureaucracies like the former state based medical boards close to the front-line are far better suited to the task. It is time to revert to self-regulation of the medical profession, with AHPRA simply providing a central register of practitioners.